Purpose:
To evaluate and identify the potential risk factors and loci of infection associated with developing endogenous endophthalmitis (EE) in patients with recorded hematogenous infections.

Methods:
MarketScan Commercial Claims and Encounters, and Medicare Supplemental and Coordination of Benefit inpatient databases from the years 2007-2011 were obtained. Utilizing ICD-9 codes, multinominal logistic regression was used to identify potential predictors and risk factors for developing endophthalmitis in patients with bacteremia, septicemia and/or fungemia. Endophthalmitis in a patient with blood infection was considered to be EE.

Results:
Among inpatient population with hematogenous infections ((n= 261,796), co-diagnosis of HIV (OR=4.27;CI,1.55-11.8;p=0.005), tuberculosis (OR=8.5;CI,1.2-61.5;p=0.03), endocarditis (OR=8.3;CI,4.9-13.9;p<0.001), bacterial meningitis (OR=3.8;CI,1.2-12.0;p=0.023), fungal meningitis (OR=59.1;CI,14.1-247.8;p<0.001), internal organ abscess (OR=2.9;CI,1.2-6.4;p=0.02), lymphoma/leukemia (OR=2.9;CI,1.6-5.3;p<0.0001), skin abscess/cellulitis (OR=1.75; CI,1.1-2.8; p=0.02), pyogenic arthritis (4.2;CI, 1.8-9.6;p=0.001) and diabetes with ophthalmic manifestations (OR=7.0;CI,1.7-28.3;p=0.006) were all significantly associated with a diagnosis of EE. However, bacterial pneumonia (OR=0.61;CI,0.28-1.3;p=0.20), intestinal infections (OR=1.84;0.86-3.94;p=0.12), chronic kidney disease/renal failure (OR=0.99;CI,0.36-2.7;p=0.98) and malignancy (OR=1.1;CI,0.7-1.8;p=0.71) were not significantly associated with developing endophthalmitis in patients with blood infections. Furthermore, when compared to patients with hospital length of stay of 3 days or less, ones with length of stay of 3-10 days (OR=1.9;CI,1.1-3.3;p=0.01), 10-30 days (OR=3.1;CI,1.8-5.5;p<0.0001) and 31+ days (OR=5.3;CI,2.7-10.4;p<0.0001) were more likely to have a diagnosis of EE. Lastly, Individuals with ICU/NICU admission were also more likely to have EE (OR=1.5;CI,1.4-1.6; p<0.0001).

Conclusions:
Among inpatient persons with hematogenous infections, we found that the odds of developing a diagnosis of endophthalmitis were significantly higher for patients with comorbidities including endocarditis, bacterial meningitis, lymphoma/leukemia, HIV/AIDS, internal organ abscess, diabetes with ophthalmic manifestations, skin cellulitis/abscess, pyogenic arthritis, and tuberculosis; patients with longer length of hospital stay; and patients with ICU/NICU admission.